REFERRALS FOR REFERRING DOCTORS. PLEASE FILL PATIENT DETAILS BELOW Preferred Doctor* Dr Leo Pang Adult and paediatric Ear Nose and Throat Surgeon Head and Neck Surgeon, Thyroid and Parathyroid Surgeon Dr Justin Kong Adult and paediatric Ear Nose and Throat Surgeon Sinus and nasal Surgeon First Available Doctor Urgent (suspected cancer referral) Ear Pain/Infection Discharge Hearing Loss Tinnitus/Vertigo Wax Other Nose Sinusitis Nasal Obstruction Rhinorrhoea Snoring Loss of smell Other Throat Discomfort/Pain Tonsillitis Neck mass Thyroid Voice/Swallowing Other Other Ear Symptom Other Nose Symptom Other Throat Symptom Patient Name* First Last DOB* MM slash DD slash YYYY Phone NumberReferrer Name* Referrer Clinic* Provider Number* Email* Comments Δ